- · Rebuilding the entrance to the residence to minimize tripping hazards and to eventually facilitate access with a walking device, wheelchair access, or electric scooter access e.g., replacing an existing saddle at a door with new saddle with a Hollywood cut that reduces a tripping hazard for foot drop, and makes it easier for a wheelchair to access the residence.
- · Widening all doorways to permit wheelchair access. This by necessity includes rebuilding all door jams and adjoining walls and woodwork. [very frequently to make the improvement required, e.g. wider doorways, ancillary modifications or reconstruction is triggered. Explain this to support the need to widen the scope of the project].
- · Widening or otherwise modifying hallways and interior doorways.
- · Installing railing, support bars, or other modifications to bathrooms, including other modifications necessary to properly installing the supports (e.g., tearing open existing walls to install proper bracing).
- · Installing non-skid tile on all bathroom floors. This is imperative to minimize the risks of falling.
- · Installing non-tile surfaces outside of bathrooms, e.g., wood kitchen flooring, to minimize injury when falling.
- · Installing new light switches closer to the floor to facilitate access.
- · Installing faucets on the side of larger sinks instead of at the back to make them more accessible.
- · Using lever faucets rather than knobs which can be difficult to turn as hand coordination wanes with disease progression.
- · Modifying hardware on doors to use “C” or “U” shaped handles located near the base of doors and cabinets so that they are both more easily reached and easier to grab if hand function deteriorates.
- · Redesigning the residence and furniture/built-ins to incorporate rest areas throughout to address the challenges of fatigue. This might include a peninsula in a redesigned kitchen with a chair so food preparation can be done while sitting, benches in showers to facilitate bathing and minimize risks of falls, a make-up table in a bathroom so personal hygiene and related activities can be done while sitting, opening up areas near closets to provide for benches so dressing activities can be completed while sitting, etc. This can preserve energy for the MS patient struggling with fatigue. [every disease and patient has her own challenges. Tailor the discussion to reflect the particular taxpayer’s situation and health challenges rather than relying on generic or broad statements].
- · Grading of all flooring to provide uniform level throughout the home avoiding the transitions from various surfaces and uneven saddles between different floor surfaces. This could require the removal of all existing flooring and installing plywood subfloors of varying height so that all final finish surfaces are level everywhere. This can be invaluable to minimize the risks of tripping due to balance issues as well as foot-drop which is very common amongst MS patients.
- · Upgraded shading and air-conditioning systems to address the sensitivity of those with multiple sclerosis to heat which further impairs nerve conduction. Automated screens and shades can facilitate handling these matters if wheelchair bound.
- · Any additional home automation that may minimize the risks of falling and facilitate managing a household by an MS patient that is, or in the future might be, wheelchair bound.
- · Safety features to address the cognitive issues that accompany MS (e.g., fire suppression, monitoring, oven shut off, etc.).
- · Oven and stove with controls that are not knobs to make it easier to use.
- · Microwave oven at a reachable level to avoid the risks of attempting reach hot liquids at high levels with the attendant risk of scalding. This will become more important as disease progression may impair hand facility or the patient becomes wheelchair bound.
- · Intercom systems to facilitate communications when mobility is limited or in the event of an emergency.
- · Installing additional outlets in locations appropriate to store and charge an electric scooter.
- · Home security to address the feelings of vulnerability common to those facing the mobility limitations of multiple sclerosis.
Home Medical Expense Deduction: Sample Doctor’s Letter
Explanation: The following is a sample letter for a physician to provide to a patient/taxpayer to use as support for claiming a home medical improvement expense deduction. The illustration uses multiple sclerosis as an example and provides indications in brackets of the type of information to add to a particular letter. Obviously, the entirety of the letter needs to be tailored to the taxpayer/patient’s particular disease and challenges. Under current law the home medical expense deduction can be a very valuable tax deduction and the tax benefits can defray the significant costs of making a residence accessible and safe in light of health challenges.
Practice Name, MD, PA
To whom it may concern:
Taxpayer/patient name was diagnosed with multiple sclerosis [name specific disease/condition] on [date of diagnosis] and I have been her physician/neurologist [list specialty] since her diagnosis. Her disease has impacted her in many profound ways. [Describe impact of disease as foundation for need for home improvements to address that condition] Chronic fatigue is one of the most disabling symptoms of multiple sclerosis and the primary cause of most people with that disease withdrawing from the workforce. Taxpayer had to give up her career as a practicing anesthesiologist on [date ceased work] as her disease progressed, a decision I encouraged her to make for her well-being. [discuss impact and ancillary factual events that support or corroborate health challenges]. Shortly after retiring she began to receive payments under her disability insurance because of the scope of her challenges. [summarize disability insurance, long term care, Social Security disability, etc. to corroborate that other third parties have acknowledged and recognized the health challenges]. Taxpayer attends physical therapy sessions four times per week, sees me approximately every three months, and consults with another neurologist, a multiple sclerosis specialist, Dr. Name annually. [describe medical care and treatment to demonstrate scope of health challenges and to further build the foundation as to why the home improvements are necessary to address the taxpayer’s medical condition]. Fatigue, balance, left foot drop, and other symptoms have worsened. [describe specific challenges of the taxpayer]. On date Taxpayer fell down a flight of stairs in her home after losing her balance. For safety sake, to avoid the potentially serious injuries such falls could create, she moved to an apartment that has no stairs and doorman services to assist her. [if the taxpayer is remaining in her existing home explain why and the need for accommodations to make that home remain usable]. To address her current balance, fatigue and other issues, as well as the potential for the worsening of her disease, she renovated that apartment extensively to accommodate current and potential future challenges. Taxpayer presently has relapsing remitting multiple sclerosis. A majority of those with this condition advance to secondary progressive multiple sclerosis. Taxpayer has been prescribed Copaxone, Avonex and presently Rebif. [while medications may not relate to the home improvements needed they corroborate the treatment, disease and may help suggest the challenges of the taxpayer]. The renovations/modifications appropriate and helpful to her current and future medical condition all reasonably include the following [describe with some specificity the improvements made and how each improvement pertains to the medical challenges of the taxpayer]:
If I can be of any additional assistance in this regards, please contact me.
Dr. Name, MD